Paediatric A and P

Question 1

Anatomy

Answer 1

Large tongue

Soft floor of mouth

Horseshoe shaped epiglottis. soft and floppy

High, anterior larynx, positioned at C3-C4

Larynx is funnel shaped in <8yr

Cricoid ring is narrowest part of airway

Trachea short and soft

Symmetry or carinal angle

Question 2

what type of laryngoscope blade for infants?

Answer 2

Straight blade

Question 3

airways increase from birth to adulthood by?

Answer 3

10 times

Question 4

Lungs

Answer 4

smaller upper and lower airways

distal airways are narrower and easily obstructed

At birth only 1/6 of alveoli present. Alveoli cluster develop over first 8 years of life.

Air alveolar interface is 3m2 at birth compared to 70m2 in adults

Question 5

Ribs

Answer 5

horizontal in infants

therefore contributes less to chest expansion and increases tidal volume.

Question 6

Chest wall

Answer 6

Thinner and less muscular

Less slow twitch muscle fibre means prone to respiratory fatigue. Pre term infants have even less.

Less subcutaneous fat makes auscultation easier to hear

Absorb higher traumatic impact as its more pliable, may be underlying damage with no significant external injuries.

Question 7

Diaphragmatic breathing

Answer 7

Intercostals are weak and ineffective.

Diaphragm is dominant for ventilation.

muscles build and ribs ossify as child develops creating a stronger structure.

Question 8

Poor carbohydrate stores

Answer 8

Use glucose stored in liver, therefore hypoglycaemia can be a problem.

Question 9

Abdominal distention

Answer 9

Can be due to weak abdominal wall muscles and size of organs.

Liver extends below the rib cage in infants and is therefore susceptible to injury.

Question 10

Anatomy for breathing overview

Answer 10

Small upper and lower airways. <12yrs obligate nasal breathers.

Immature lungs

Horizontal ribs

Compliant chest wall

Diaphragmatic breathing

More prone to respiratory failure

Vulnerable abdominal contents

Question 11

Slight blockage of nasal passages

Answer 11

Can reduce breathing capacity in 0-6 months:

Easily blocked by secretion.

Small airways have an increased susceptibility to infection and oedema.

URTI’s are one of the most common reasons for paediatric presentation.

Question 12

Adenotonsiilar hypertrophy (AH)

Answer 12

Caused by recurrent or chronic infections, leading to AH

Can be worsened by URTI’s

Can cause:

Difficulty feeding small children.

Mouth breathing.

Noisy respirations.

Stridor.

Loud snoring and sleep apnea.

Question 13

Ventricular size

Answer 13

At birth ventricles are similar size and weight, but Right side is dominant.

by 4-6 months the Left ventricle is dominant.

Question 14

Blood volume

Answer 14

newborn: 80 ml/kg

decreases with age to 60-70 ml/kg

NB. 125ml of blood loss form cord is 50% blood loss

Question 15

Increased Respiratory Rate

Answer 15

Higher metabolic rate.

Greater O2 consumption.

Question 16

Signs of respiratory distress

Answer 16

Recession.

Abdominal breathing.

Nasal flaring.

Grunting.

NB. chest recession in a child >6yr shows significant illness.

Question 17

Circulation

Answer 17

Stroke volume relatively fixed until two years.

Respond to shock with tachycardia.

Cardiac output related to pulse rate.

Less able to respond to fluid resuscitation.

Cardiovascular emergencies are relatively rare.

NB. <2yr old bradycardia can be a sign of imminent cardiorespiratory arrest.

Question 18

Thermoregulation

Answer 18

Brown fat used for heat production in first year of life.

Depletion coincides with the kicking in of the shivering reflex.

Deposits around kidneys, neck and upper chest.

Metabolic acidosis may result from hypothermia as not enough gas exchange for the work that’s being done. Hypothermia may indicate sepsis in the newborn.

Question 19

Body proportions - Body Surface Area (BSA)

Answer 19

BSA to weight ratio:

Decreases with age.

Small children with a high ratio lose heat quicker.

high BSA increases risk of hypothermia due to potential for rapid heat loss.

Question 20

Hypoglycaemia

Answer 20

Not only present in diabetics

A reaction to stress

Poor glycogen stores coupled with high metabolic rate

When are we going to BM test children?
Seriously unwell, prolonged seizure, altered consciousness.

Can be due to patient being cold and brown fat metabolism causing reduced glucose levels.

NB. don’t give DKA children fluids UNLESS they have hypovolaemic shock. Fluids can cause cerebral oedema if given too fast.

Question 21

Intra abdominal organs

Answer 21

Closer proximity to each other.

Liver and spleen may extend below the costal margin.

Bladder extends higher out of pelvis.

Kidneys more anterior and not protected as well as adults due to compliant chest wall and immature abdominal muscles.

Less fat and muscle to protect organs.

Question 22

Renal systems

Answer 22

Renal blood flow and glomerular filtration are low in the first two years of life due to high renal vascular resistance.

Question 23

Liver function

Answer 23

Initially immature with decreased function of hepatic enzymes.

Barbiturates and opioids have a longer duration of action due to the slower metabolism.

Question 24

Psychology

Answer 24

Communication

Parental involvement

Age regression - when sick 5yr could act like 3yr old.

Fear/pain/guilt